Have you done a market survey? How many physicians are available in your catchment area? How many urgent cares or primary care offices are in your area? Are you going to do chronic disease management, or just urgent care?  

MGMA can probably give you some malpractice insurance data. Are your docs gonna be employees or contractors on a 1099?

Have you talked with a few doctors in the area? Do you have a feel for health insurance penetration in the area? A lot of physicians are really struggling to keep their clinics afloat, especially with the incoming onslaught on patients who will be on Medicaid once ObamaCare is fully enacted.

As a small clinic, you will have ZERO negotiating power with any of the local or regional insurance companies. Let me repeat that. ZERO. They will offer you a shit fee schedule, with payment about 50-60% of the allowed Medicare payment. Medicare doesn't negotiate fees at all. Neither does Medicaid, although some of the managed Medicare and Medicaid companies have different fee schedules. They all suck. You lose money on Medicaid, break even on Medicare, and make money on commercial insurance, IF you have a good contract with them.

You'll need an electronic medical record, and the ability to submit claims and receive payments electronically. There are startup and maintenance costs associated with EMRs, but they're not too bad for a small clinic.

How many medications are you going to stock? Injectable meds can get expensive. If you stock controlled substances, there are significant layers of bureaucracy associated with them, and your theft risk goes up dramatically. If you keep Demerol and Valium injectables in the clinic, you will get robbed. Just keep Toradol and Phenergan shots. They're cheap, and no druggies will break in for them.

If I were opening a standalone clinic, I'd run a light crew, with one receptionist, and one nurse or MA, and one physician. Hire two docs. Each can do three 12 hours shifts per week. That covers Mon-Sat. Do you want to be open Sunday?

Do not contract with Medicare or Medicaid at all. Have a set charge for an acute care visit (ear infection, strep, migraine, flu). You might consider posting your fees for sutures, X-rays (if you're gonna do them), injections of medications, etc. If there aren't many urgent care clinics around, you might be able to get some decent contracts with some of the commercial insurance plans. Tout your clinic's availability for routine and urgent matters, and the opportunity to keep their subscribers out of the ER. However, if you do cash-only, you will significantly lower your business overhead expenses.

Just realize that patients will bitch and moan that they have to pay to be seen. After all, "I've got my Medicaid and you have to see me!" Make sure patients pay the charge BEFORE they are brought back to be seen. You'll never have any luck collecting after the fact.

Finally, a couple of thoughts of salaries/wages. I get several brochures or flyers in the mail every week, advertising available Family Medicine positions all over the country. Most are $200-250K/year, and some have production bonuses or incentives that go even higher. If you pay the docs as 1099 contractors, plan on $125/hr or higher and you pay the malpractice premium.

So, does that help a bit?